Longitudinal Trajectories of Hospitalizations in U.S. Older Adults with Heart Failure
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2026
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Abstract
Abstract Background Little is known about long-term risks of hospitalizations among heart failure (HF) older adults at a national level. We identified long-term patterns of hospitalizations following the diagnosis of HF and assessed whether high-risk patients can be identified prior to discharge. Methods This is a retrospective cohort study from 2010 to 2020. Fee-for-service Medicare beneficiaries with newly-diagnosed HF during an inpatient stay and followed for up to 5 years. Group-based trajectory models (GBTM) identified 4 trajectories of all-cause hospitalizations during follow-up. LASSO regression was used to identify patients’ baseline characteristics to predict their hospitalization trajectories. Model discrimination was assessed using C-statistics and calibration was evaluated using expected-to-observed ratios. Results Of the 84,597 Medicare beneficiaries with newly-diagnosed HF (mean age: 77.4 [± 7.1] years and 58.3% male), we identified 4 distinct trajectories of hospitalizations: Group 1 (n = 19,340; 22.9%) had consistently “low risks” of hospitalization, Group 2 (n = 53,922; 57.9%) had elevated risks shortly after discharge (“high-to-low risk”), Group 3 (n = 5,035; 9.8%) had elevated risks at later stages of illness (“low-to-high risk”), and Group 4 (n = 6,300; 9.4%) had consistently “high risks” of hospitalization. Models were well-calibrated predicting hospitalization trajectories (compared to low-risk patients [Group 1]), and C-statistics were 0.65 (Group 2), 0.68 (Group 3), and 0.79 (Group 4). Discrimination was consistently better among patients ≤70 years and calibration remained excellent across all subgroups with expected-to-observed ratios near 1.0. Conclusions High-risk HF patients could be identified at the time-of-diagnosis using routinely available clinical characteristics, enabling targeted interventions during critical periods to improve long-term outcomes.
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openalex_W7213462876
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| Authors | Hanzhang Xu, Radha Dhingra, Bradley G. Hammill, Zhen Li, Scott M. Lynch, Jessica West, Michael D. Green, Eric D. Peterson, Lesley H Curtis, Matthew E Dupre |
| Journal | the journals of gerontology series a, biological sciences and medical sciences |
| Year | 2026 |
| DOI |
10.1093/gerona/glag233
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| URL | |
| Keywords | Keywords not found |
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